控制肺心病急性加重期糖代谢异常与患者预后的关系

目的:探讨用胰岛素控制肺心病患者急性加重期糖代谢异常与预后的关系。方法:对2004年6月~2007年6月住院治疗的肺心病急性加重期患者162例进行空腹血糖监测,发现非糖尿病性急性高血糖患者101例,血糖正常61例。非糖尿病性急性高血糖患者随机分为胰岛素干预组50例及对照组51例,收集患者基本信息、血糖检测结果、平均住院日数、住院期间死亡率等。结果:平均住院日持续性高血糖干预组为17±10 d,对照组24±12 d,差异有统计学意义(P=0.01)。正常血糖组为16±11 d,干预组与对照组比较差异无统计学意义(P=0.35)。住院期间死亡率正常血糖组为21.3%,持续性高血糖对照组为33.3%,干预组为18.0%。高血糖干预组与对照组比较住院期间死亡率差异具有统计学意义(P=0.001)。结论:肺心病患者糖代谢异常发生率高,积极控制患者血糖能改善患者的预后。     

血糖升高对慢性阻塞性肺病急性加重期近期预后的分析

目的:分析与研究血糖升高对慢性阻塞性肺病急性加重期近期预后的造成的影响。方法:将75例AECOPD患者根据血糖水平分为血糖升高组(30例)和血糖正常组(45例)。对2组患者痰培养阳性率、病死率及住院时间等进行比较。结果:2组痰菌培养阳性率存在显著差异(P<0.05)。血糖升高组住院时间为(18.7±2.1)d,病死率为13.3%(4/30);血糖正常组住院时间及病死率分别为(12.2±2.0)d及4.4%(2/45),2组比较差异均有统计学意义(均P<0.01)。结论:高血糖水平会对AECOPD患者的预后产生不利影响。只有对AECOPD患者新发的高血糖水平进行严格控制,才能确保患者的预后。     

Influence of hyperglycemia on the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease

目的 探讨高血糖对慢性阻塞性肺病(COPD)急性加重期预后的影响.方法 收集2009年1月至2010年2月于我院住院治疗的COPD急性加重期患者75例,根据患者入院时空腹血糖或随机血糖测定结果,分成高血糖组42例,血糖正常组33例,比较两组患者一般临床资料、住院期间的并发症发生和病死情况.结果 高血糖组中高血脂、PaCO2＜60mmHg及PaCO2＞50 mmHg的病例数明显多于血糖正常组(P＜0.05).高血糖组患者肺心病、呼吸衰竭、肾功能不全、肺功能异常及心力衰竭的发生率均明显高于血糖正常组(P＜0.05),住院天数明显长于血糖正常组(P＜0.05),住院期间病死率也明显高于血糖正常组(P＜0.05).结论 高血糖对AECOPD患者的预后存在明显的不利影响.     

血糖升高对慢性阻塞性肺病急性加重期近期预后的分析

目的：分析与研究血糖升高对慢性阻塞性肺病急性加重期近期预后的造成的影响。方法：将75例AECOPD患者根据血糖水平分为血糖升高组（30例）和血糖正常组（45例）。对2组患者痰培养阳性率、病死率及住院时间等进行比较。结果：2组痰菌培养阳性率存在显著差异（P＜0.05）。血糖升高组住院时间为（18．7±2．1）d ，病死率为13．3％（4／30）；血糖正常组住院时间及病死率分别为（12．2±2．0）d 及4．4％（2／45），2组比较差异均有统计学意义（均P＜0．01）。结论：高血糖水平会对AECOPD患者的预后产生不利影响。只有对AECOPD患者新发的高血糖水平进行严格控制，才能确保患者的预后。     

慢性阻塞性肺疾病急性加重期合并高血糖患者强化血糖控制的护理

目的研究护理在慢性阻塞性肺疾病急性加重期合并高血糖患者强化血糖控制中的意义。方法采用同期、平行、随机对照试验的方法对研究对象的疗效进行分析。结果经治疗和有效的护理后实验组治疗有效率为86.5%,高于对照组62.5%,差异有统计学意义,P〈0.05。实验组的平均住院天数（12.1±4.7）d,明显短于对照组（16.3±13.3）d,差异有统计学意义,P〈0.05。实验组病死率为4.1%,对照组病死率为7.5%,两组病死率差异无统计学意义（P〉0.05）。结论合理的护理措施和强化血糖控制能提高患者的治疗有效率。     

参麦注射液对慢性肺源性心脏病96例疗效观察

目的观察参麦注射液在慢性肺源性心脏病患者治疗中的疗效.方法将慢性肺源性心脏病患者96例分成观察组48例和对照组48例,对照组给予西医综合治疗,观察组在对照组的基础上加用参麦注射液静滴治疗,2周为一个疗程,两个疗程后比较两组临床疗效、不良反应及住院时间.结果观察组总有效率(85.5%)高于对照组(60.4%),差异有统计学意义(P<0.05),观察组住院时间(14.2±2.5)天,对照组(19.5±3.8)天,两组差异有统计学意义(P<0.05).结论参麦注射液能显著缓解慢性肺源性心脏病患者的临床症状,疗效肯定,且能缩短住院时间,适合临床推广.     

纳洛酮治疗慢性肺心病急性加重期疗效观察

目的 探讨和观察纳洛酮在慢性肺心病急性加重期应用的价值和效果.方法 将78例慢性肺心病急性加重期患者随机分为对照组及治疗组,两组均给予常规治疗,在此基础上,治疗组加用纳洛酮注射液,按1 μg/(kg·min)的速度持续静滴10 h,1次/d,10～14 d为一个疗程,观察治疗前后临床疗效并作血气分析.结果 治疗组总有效率为89.7%,对照组总有效率为71.8%,两组疗效比较差异有统计学意义(P<0.05),治疗组治疗前后对照,PaCO2明显下降,PaO2明显上升,差异有统计学意义(P<0.01),两组治疗后比较,治疗组PaCO2、PaO2均优于对照组,差异有统计学意义(P<0.05或P<0.01).结论 纳洛酮治疗慢性肺心病急性加重期疗效显著.     

低分子肝素联用酚妥拉明改善肺心病急性加重期患者心肺功能的研究

目的 为了提高慢性肺源性心脏病(简称肺心病)急性加重期患者心肺功能,探究低分子肝素联用酚妥拉明对于改善心肺功能的有效性.方法 选取2012年9月-2014年9月在绍兴第二医院进行治疗的慢性肺源性心脏病急性加重期患者120例,分为观察组和对照组,并且入院后都进行常规治疗.观察组60例患者在常规治疗的基础上进行低分子肝素与酚妥拉明联用;对照组60例患者给予参麦注射液治疗.治疗1个疗程后分析比较2组咳嗽、气喘及肺部哕音、心功能和血气的变化情况.结果 治疗后,观察组显效26例,有效28例,无效6例,总有效率为90.0％.对照组显效14例,有效31例,无效15例,总有效率为75.0％.观察组患者疗效明显好于对照组,2组总有效率比较差异有统计学意义(P＜0.05).观察组患者PaO2由治疗前的(56.3±8.5) mm Hg增加到(83.2 ±9.2)mm Hg,PaCO2由治疗前的(73.4±10.2)mm Hg降低到(54.2±9.4) mm Hg;对照组患者PaO2由治疗前的(56.9±8.2) mm Hg增加到(75.6±9.4)mm Hg,PaCO2由治疗前的(74.1 ±10.6)mm Hg降低到(66.8±9.3)mm Hg.由此可以看出观察组的治疗效果明显好于对照组.2组患者在治疗前后对比差异具有统计学意义(P＜0.05).结论 低分子肝素与酚妥拉明联用能够有效改善慢性肺源性心脏病急性加重期患者的心肺功能,并且效果良好,值得临床推广应用.     

慢性肺源性心脏病急性加重期患者的护理

目的探讨慢性肺源性心脏病急性加重期的观察与护理措施。方法分析78例肺源性心脏病患者的临床资料,密切观察病情,及时处理并发症,采取有效的护理措施。结果78例肺源性心脏病患者经精心的治疗和护理均好转出院,平均住院时间13 d.结论充分掌握肺源性心脏病的病理生理特征,密切观察病情,加强护理是预防并及时处理并发症,缩短病程,提高疗效,降低病死率的关键。     

高血糖对COPD急性加重期患者预后的影响

目的探讨高血糖对慢性阻塞性肺病(COPD)急性加重期预后的影响。方法收集2009年1月至2010年2月于我院住院治疗的COPD急性加重期患者75例,根据患者入院时空腹血糖或随机血糖测定结果 ,分成高血糖组42例,血糖正常组33例,比较两组患者一般临床资料、住院期间的并发症发生和病死情况。结果高血糖组中高血脂、PaCO2<60mmHg及PaCO2>50mmHg的病例数明显多于血糖正常组(P<0.05)。高血糖组患者肺心病、呼吸衰竭、肾功能不全、肺功能异常及心力衰竭的发生率均明显高于血糖正常组(P<0.05),住院天数明显长于血糖正常组(P<0.05),住院期间病死率也明显高于血糖正常组(P<0.05)。结论高血糖对AECOPD患者的预后存在明显的不利影响。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.